Strömberg Sofia, Holsti Mari, Persson Sven-Erik, Nordanstig Annika, Nordanstig Joakim, Johansson Elias
Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Surgical and Peri-operative Sciences, Umeå University, Umeå, Sweden.
Eur J Vasc Endovasc Surg. 2024 Dec;68(6):704-711. doi: 10.1016/j.ejvs.2024.08.007. Epub 2024 Aug 10.
The aim of this study was to determine how many pre-operative ischaemic events occurring within a specific timeframe before carotid endarterectomy (CEA) are needed to increase the peri-operative 30 day risk of stroke or death.
This was a secondary exploratory analysis based on pooled data from three observational studies sourced from a single centre. Patients with recently symptomatic conventional ≥ 50% carotid stenosis were included. The principal analysis was limited to patients presenting with stroke or transient ischaemic attack (TIA). The primary outcome was 30 day risk of peri-operative stroke or death. Whether one, two, three, or four or more ipsilateral pre-operative ischaemic events within three, seven, 14, or 30 days before CEA were associated with the primary outcome was assessed.
The study included 382 patients who underwent CEA with symptomatic conventional ≥ 50% carotid stenosis with stroke or TIA as the presenting event. Mean patient age ± standard deviation was 72 ± 7 years, 117 (30.6%) were female, and 5% were treated with dual antiplatelet therapy. The primary outcome occurred in 21 patients (5.5%). Two or more events within 7 days before CEA was the most discriminative definition of repeated events, with a 14.3% (8/56) risk of the primary outcome. Those who fell outside this definition of two or more events within seven days before CEA had a 4.0% (13/326; p = .006) risk of experiencing the primary outcome (adjusted odds ratio 4.1, 95% confidence interval 1.6 - 10.5). Several alternative definitions were assessed, but patients with two or more events within seven days before CEA and negative for these alternatives still had a > 10% risk of the primary outcome.
Two or more ipsilateral ischaemic events within seven days before CEA is associated with an increased risk of peri-operative stroke or death in cases with symptomatic conventional ≥ 50% carotid stenosis and TIA or stroke as the presenting event. Studies assessing whether delayed or immediate CEA is preferable for this patient group are warranted.
本研究旨在确定在颈动脉内膜切除术（CEA）前的特定时间段内发生多少例术前缺血事件会增加围手术期30天内发生中风或死亡的风险。
这是一项基于来自单一中心的三项观察性研究汇总数据的二次探索性分析。纳入近期有症状的、传统的颈动脉狭窄≥50%的患者。主要分析限于出现中风或短暂性脑缺血发作（TIA）的患者。主要结局是围手术期30天内发生中风或死亡的风险。评估在CEA前3天、7天、14天或30天内发生1次、2次、3次、4次或更多次同侧术前缺血事件是否与主要结局相关。
该研究纳入了382例行CEA的患者，这些患者有症状性传统颈动脉狭窄≥50%，以中风或TIA为首发事件。患者的平均年龄±标准差为72±7岁，117例（30.6%）为女性，5%接受双联抗血小板治疗。21例患者（5.5%）出现了主要结局。CEA前7天内发生2次或更多次事件是重复事件最具判别性的定义，主要结局风险为14.3%（8/56）。那些不符合CEA前7天内发生2次或更多次事件这一定义的患者发生主要结局的风险为4.0%（13/326；p = 0.006）（调整后的优势比为4.1，95%置信区间为1.6 - 10.5）。评估了几种替代定义，但CEA前7天内发生2次或更多次事件且不符合这些替代定义的患者发生主要结局的风险仍>10%。
对于有症状性传统颈动脉狭窄≥50%且以TIA或中风为首发事件的患者，CEA前7天内发生2次或更多次同侧缺血事件与围手术期中风或死亡风险增加相关。有必要开展研究评估该患者群体延迟或即刻进行CEA哪种更可取。
